Introduction

This article provides a short historical review about health care in Muslim
experience, as well as current general information about Muslim people and
their main observances and concerns in the Western health care system. Muslims
in the U.S. come from many different cultures and schools of thought. A detailed
explanation about differences is beyond this article's scope and purpose. This
document focuses on similar beliefs and observances with regard to health care,
illness, and death and dying among Muslims in the US.

Finally this document offers a list of suggested readings and resources available
on the Internet.

NoteIn the body of this article, common Islamic concepts
or terms are linked to external websites that provide more information. These
websites are noted, along with additional resources in the Suggested
Resources at
the end of this article.

General Information

The word “Islam” means peace and submission to the will of Allah (translated
literally as “the God”); those who follow Islam are called Muslims.
Islam is one of the three Abrahamic religions after Judaism and Christianity.
In the 7 th century C.E. Islam emerged in the Arabian Peninsula, or present
day Saudi Arabia. Muslims believe that there is only one God and that Muhammad
was the last Prophet of God. They also believe that God revealed teachings
to Muhammad, which are recorded in the Islamic Holy Scripture: the Qur'an. The Qur'an advises
Muslims on their religious duties, including the five
pillars, or religious obligations, including confession of faith, prayer,
fasting, charity, and pilgrimage.

Muslims consider the Prophet Muhammad as an exemplar and they try to emulate
his deeds in their own lives by following his traditions and the Qur'anic instructions.
Such teachings have historically influenced attitudes and practices toward
different aspects of life including birth, illness, and death and dying, as
well as the development of political, social and economic structures. These
factors often impact policies on health care and shape Muslim sub-communities'
attitudes about receiving medical treatment from the larger non-Muslim society.

During the early period of development, Islam was influenced by different
factors including the cultural practices of newly conquered lands. Muslim rulers
in these regions had to be rather flexible and they adopted and improvised
many existing local practices; therefore, innovations in health care practice
were accepted provided that they did not conflict with Islamic Law (Shari'ah).

Shari'ah considers Muslims as one community (Ummah)
and prescribes their activity from birth to death. Measures for basic health
care in Islamic Law include diet and personal hygiene. Due to differences between
local personal habits, different interpretations of the Shari'ah developed
during the early period of Islam. These interpretations resulted in the development
of five
distinct schools of Fiqh, or Islamic jurisprudence. Although
these schools interpret the Shari'ah based on their own theological approach,
they share nearly the same fundamental beliefs on the matter of death and dying.

Pre-Modern Medicine in Islamic Experience

There are no specific codes for medical treatment of physical illnesses in
the Qur'an. In Islamic tradition the difference between health and
illness was, and still is, perceived as balance
and imbalance or the Humoral Theory. Muslims have historically sought the Qur'an as
a healing source in times of psychological and spiritual distress. When experiencing
physical illness, Muslims have also been open to the rituals and medicinal
practices of different traditions, including those of non-Muslims. The following
sayings of the Prophet are used to encourage patients to seek proper treatments
in time of illness:

Historically, there has been a close relationship between religion and medicine
and its practices. Muslims have been open to accept, use and improve non-Muslim
as well as pre-Islamic healing rituals. They have adopted and improvised many
practices such as home-made herbal and medicinal tonics, dietary restrictions,
and amulets to ward off bad spirits. They also have adopted practices such
as male circumcision, cupping, bloodletting, cauterization and ligaturing.
During the pre-modern era, Islamic medical and other sciences leaned heavily
upon local medical practices, as well as on works translated from Greek. These
influences resulted in the further advancement of medical sciences, especially
in the 11th and 12th century.

Modern Period

One of the most significant changes in Islamic history occurred toward the
end of the Ottoman period. During this transition the previously united Islamic
world was fragmented into many newly independent Muslim countries due to the
dissolution of the Ottoman Empire and the expansion of Western colonialism.
These changes resulted in socio-political appropriation and adaptation of European
influences, such as constitutional models and family law, as well as accepted
medical treatments. As the result state-supported public and local health clinics
were established and local therapeutic traditions experienced decline. By the
end of the 19th to the beginning of the 20th centuries in many Muslim states/nations,
the aim of state-sponsored health clinics was to eliminate local diseases and
to provide education about reproduction.

While European medical practices were strong influences in early modern Muslim
societies, it should also be noted that the sciences in Europe did not arise
in a vacuum. Rather, they were historically based upon the Greco-Arabic
medicinal sciences .

Contemporary Approach

Contemporary Muslims' approach to health care is still strongly based on preventative
measures. In many cases, although Muslim patients seek a curative process through
surgical or medical means, they still look to their religious and cultural
heritage to address their spiritual, social and cultural needs. Preventative
healthcare strategies in Muslim experience include: personal hygiene, dietary
measures such as the restriction in eating specific ingredients (such as pork
and its byproducts, and drinking alcohol), and the avoidance of addictive habits
such as smoking tobacco or over-consumption of food.

The Muslim population in the US is very diverse and colorful. The cultural
background of different Muslim groups might influence the way in which they
respond to illness and other life crises. For example, some Muslims may perceive
a sudden death or illness as a sign of punishment, or a test from God. Moreover,
when an immigrant Muslim family moves to a larger non-Muslim society they may
adopt certain elements of their new cultural environment. However, one aspect
that is usually the same regardless of country of origin is in relation to
the practices surrounding death and dying.

Life

In Islam, life is considered sacred and belongs to God. (002.164 ; 003:156).
It is believed that all creatures die at a time determined by God (029:57 ; 003:185).
Therefore, suicide (002:195)
and euthanasia are forbidden. DNR orders are acceptable:

“The Islamic perspective on do-not-resuscitate orders has been described
and is complex. A do-not-resuscitate order is consistent with the tenets of
Islam. The withdrawal of support in the setting of a persistent vegetative
state is less clear”. (Naughton and Davis, 2001).

Muslims believe in the after life. The Qur'an emphasizes that death is just
a transition for the soul to depart the body and enter into another realm (002:28; 002:56).
Muslims also believe in God's mercy and forgiveness (002:54; 004:96) .
In times of illness Muslims find strength from prayer and meditation, and may
find spiritual healing in reciting the Qur'an, particularly if they perceive
their illness as a test or punishment from God (003:17).
Therefore, it can be very helpful and comforting to provide Muslim patients
and their families a copy of the Qur'an and access to a private space to perform
their daily prayers.

The Fatwa
no. V: of this conference reads: “A person is considered legally dead
and all the Shari'ah's principles can be applied when one of the following
signs is established:

(i) Complete stoppage of the heart and breathing which are decided to be irreversible
by doctors.

(ii) Complete stoppage of all vital functions of the brain which are decided
to be irreversible by doctors and the brain has started to degenerate. Under
these circumstances it is justified to disconnect life supporting systems even
though some organs continue to function automatically (e.g. the heart) under
the effect of the supporting devices”
(Hassaballah,1996).

Since death is viewed as a process that bridges the soul's existence from
one life to the next, it is acceptable to
discontinue the use of life support equipment that prolongs the life of a patient.
In medically-futile situations, in which life support equipment is used to
prolong organ functions, the condition needs to be carefully explained to the
family so they do not mistake DNR orders with euthanasia.

When death happens, Muslims believe that the soul returns to his or her creator
(002:156).
The family members of the deceased immediately prepare to perform the burial
as soon as possible. If death occurs in a hospital or hospice, the face of
the deceased person or his/her bed should be turned toward Mecca (in a northeast
direction in the United States). The clothes are removed by same gender family
members and the body will be covered by sheets. The family quickly prepares
the arrangements for washing (ghusl) and
Islamic burial .

In Islam, the body is sacred and belongs to God; therefore, autopsy examinations
are only allowed when legal requirements demand it. Embalming and cremation
are forbidden in Islam; therefore, the families try to bury their loved ones
before the body decays. At the time of death of a loved one, Muslims usually
are supported by their community of affiliation and mosques. When an unexpected
or sudden death occurs, hospitals may receive a large number of visitors and
community members to support the patient and family.

(See also in EthnoMed cultural information about Somali Muslims, including
information about funeral traditions, beliefs surrounding death and encounters
with the medical examiner: Somali
Cultural Profile)

Important Religious and Cultural Facts in Providing Care

In caring for hospitalized Muslim patients, the following information will
help to provide a more comfortable stay for patients, and will facilitate communication
between staff and their patients and families.

Scripture

To support psychological and spiritual health and healing, it is widely believed
that reading and reciting the Qur'an brings blessings to those who
are spiritually and psychologically distressed; therefore, providing a copy
of the Qur'an to Muslim patients is helpful.

Muslim Women

Muslim women prefer to have same gender doctors and nurses in order to follow
rules of modesty in regard to the opposite sex. Related to this, Muslim women
cover their head and body in various Islamic coverings (Hijab),
according to the custom of their country of origin. To show respect, healthcare
workers should ask a Muslim woman for permission to uncover parts of her body
for injection, or for any other medical reasons.

It is helpful to have a sign on female Muslim patients' door asking the staff
to knock first before entering. This will provide them a few seconds to put
on their Hijab. Additionally, it is helpful to provide a sign requesting that
medical staff return in a few minutes in order to give female patients enough
time and privacy to perform their daily prayers.

Diet and Food Restriction

Muslims follow dietary requirements that may affect compliance with prescriptions.
Muslims avoid eating pork or drinking alcohol, and are proscribed from taking
medicines that contain alcohol or pork byproducts unless they are life-saving
drugs and no substitute is available. Usually at a time of necessity Muslims
follow the general rule that “necessity dictates exception” (016:115 ; 012:068 ; 006:145 ):

“Porcine heparin, for example, contains gelatin from pork products, and is
the only heparin universally used. That was thought to cause a potential problem
for Jewish, Muslim, and Seventh-day Adventist patients at this institution," says
Doha Hamza, the coordinator of Muslim volunteers at the spiritual care service
department at Stanford (CA) University Medical Center. "We investigated
the issue with an Imam and a Muslim doctor who concurred that the use of porcine
heparin is lawful because of the chemical modification the product undergoes
and the urgent need involved. Also the amount is so small, it doesn't fit the
definition of consumption." Similar solutions might be found for insulin
products* derived from pork and porcine heart valves” (Pennachio, 2005).

Important Dates

Eid Fitr and Eid
Adha are two of the most important holidays which all Muslims recognize.
On these two days, Muslims visit hospitals to visit their communities' patients,
as well as cemeteries. Eid Fitr celebrates the final day of Ramadan. On the
Eid Fitr, the fast is broken and all Muslims gather in community to celebrate
with a celebratory community meal. On that day the head of each household
pays their annual alms to a charity of their choice. Eid Adha occurs during
the Hajj (pilgrimage) which celebrates the willingness of Abraham to sacrifice
his son Ismael (Ishmael). On these important dates, healthcare workers may
see an increase in visitors for their Muslim patients.

Prayer

Devout Muslims pray (salaat)
5 times a day. Daily salaat is mandatory and performed at dawn, noon, mid afternoon,
sunset, and late night. It is helpful to direct the bed of a terminally ill
Muslim patient toward Mecca (in a northeast direction in the United States)
for spiritual reasons. Also it should be noted that Muslims ritually wash (Wuzu)
before their daily prayers. This ritual includes washing the arms, face, mouth,
ears, and feet each time before prayers. Therefore, if a patient desires to
engage in this practice, extra effort will be needed from the medical team
and nurses to help the patient meet this requirement.

Transplants

Since there are no specific codes on transplant and
organ donation in the Shari'ah, there are different approaches to treatment.
Most Muslim jurists and their followers accept organ donations because it is
in harmony with the Islamic principle of saving lives. (5:32)

“The following requirements should be met before transplantation: (1) a transplant
is the only form of treatment available; (2) the likelihood of success is high;
(3) the consent of the donor or next of kin is obtained; (4) the death of the
donor has been established by a Muslim doctor; (5) there is no imminent danger
to the life of a living donor; and (6) the recipient has been informed of the
operation and its arrangement for ritual body wash” (Sarhill, N., LeGrand,
S., Islambouli, R., Davis, M. P., & Walsh, D. (2001).

Porter, B. (2001). The muslim festival of eid ul-fitr at L'arche daybreak:
A pattern and principles for common worship services in solidarity with those
not of the majority faith. Journal of Pastoral Care, 55 (2), 197-200.